Green A, Shaddick G, Charlton R, Snowball J, Nightingale A, Smith C, Tillett W, McHugh N
Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, U.K.
Department of Mathematical Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, U.K.
Br J Dermatol. 2020 Mar;182(3):714-720. doi: 10.1111/bjd.18227. Epub 2019 Sep 2.
Psoriatic arthritis (PsA) is a progressive and often destructive joint disease affecting approximately 20% of people with psoriasis.
To investigate associations between obesity, changes in body mass index (BMI), alcohol intake and smoking status and the development of PsA in people with psoriasis.
We undertook a cohort study involving incident cases of psoriasis identified from the U.K. Clinical Practice Research Datalink between 1998 and 2014. The associations between smoking, alcohol and BMI and development of PsA were assessed using generalized additive models. Additionally, the risks associated with a change in BMI during follow-up were investigated using distributed lag nonlinear models.
We identified 90 189 incident cases of psoriasis (42% male, mean age 51 years), of whom 1409 had a subsequent record of PsA diagnosis. BMIs of 25·0-29·9, 30·0-34·9 and ≥ 35·0 kg m were significantly associated with an increased risk of developing PsA compared with BMIs < 25·0 kg m : adjusted odds ratios (95% confidence intervals) 1·79 (1·46-2·19), 2·10 (1·67-2·63) and 2·68 (2·09-3·43), respectively. Reducing BMI over a 10-year period (linearly) was associated with a reduction in the risk of developing PsA compared with BMI remaining constant over the same period. Increased risks of developing PsA were associated with moderate drinking but not with former or heavy drinking or with current or past smoking status.
In this incident psoriasis cohort, increased BMI and moderate drinking, but not heavy drinking or smoking status, were associated with an increased risk of PsA in people with psoriasis. Importantly, we have shown that reducing weight may result in a reduction in the risk of developing PsA. What's already known about this topic? There is some evidence that increased body mass index is associated with an increased risk of developing psoriatic arthritis. There are conflicting results surrounding the relationship between smoking and the development of psoriatic arthritis among patients with psoriasis. What does this study add? Using a nonlinear and lagged effect of body mass index measured over time we have shown that reducing body mass index may be associated with a reduction in the risk of developing psoriatic arthritis. We have found no evidence that smoking alters the risk of developing psoriatic arthritis in patients with psoriasis.
银屑病关节炎（PsA）是一种进行性且通常具有破坏性的关节疾病，影响约20%的银屑病患者。
调查肥胖、体重指数（BMI）变化、酒精摄入和吸烟状况与银屑病患者发生PsA之间的关联。
我们进行了一项队列研究，纳入了1998年至2014年间从英国临床实践研究数据链中确定的银屑病新发病例。使用广义相加模型评估吸烟、饮酒和BMI与PsA发生之间的关联。此外，使用分布滞后非线性模型研究随访期间BMI变化相关的风险。
我们确定了90189例银屑病新发病例（42%为男性，平均年龄51岁），其中1409例随后有PsA诊断记录。与BMI<25.0kg/m²相比，BMI为25.0 - 29.9、30.0 - 34.9和≥35.0kg/m²与发生PsA的风险增加显著相关：调整后的比值比（95%置信区间）分别为1.79（1.46 - 2.19）、2.10（1.67 - 2.63）和2.68（2.09 - 3.43）。与同期BMI保持不变相比，在10年期间（线性）降低BMI与发生PsA的风险降低相关。发生PsA的风险增加与适度饮酒有关，但与既往或大量饮酒以及当前或既往吸烟状况无关。
在这个银屑病新发病例队列中，BMI升高和适度饮酒与银屑病患者发生PsA的风险增加有关，但大量饮酒或吸烟状况无关。重要的是，我们已经表明减轻体重可能会降低发生PsA的风险。关于这个主题已经知道了什么？有一些证据表明体重指数升高与发生银屑病关节炎的风险增加有关。关于吸烟与银屑病患者发生银屑病关节炎之间的关系存在相互矛盾的结果。这项研究增加了什么？通过使用随时间测量的BMI的非线性和滞后效应，我们已经表明降低体重指数可能与降低发生银屑病关节炎的风险有关。我们没有发现证据表明吸烟会改变银屑病患者发生银屑病关节炎的风险。
